Hyperglycemia and Outcome in the Pediatric Intensive Care Unit
Received 17 August 2007; received in revised form 21 December 2007; accepted 2 April 2008. published online 27 May 2008.
Objective
To identify the frequency of hyperglycemia in children who are nondiabetic and critically ill and assess the independent effect of hyperglycemia on outcome.
Study design
Consecutive admissions to the pediatric intensive care unit (PICU) were reviewed. The Pediatric Risk of Mortality III score (PRISM) measured patient acuity. Because maximum glucose level in the first day of PICU admission (GLFD) >200mg/dL contributes to PRISM, 200 mg/dL was used to differentiate high glucose (HG) from normal glucose.
Results
Of 1550 patients, 221 (14.3%) had HG. GLFD correlated with PRISM (r = 0.39, P < .001). Without controlling for PRISM, the HG group had more mechanical ventilation days (MVD; P < .001), longer PICU length of stay (PLOS; P < .001) and lower percent survival (P < .001) than the normal glucose group. Controlling for PRISM in survivors, GLFD was not associated with PLOS (P = .75) or with MVD (P = .06). GLFD was not significantly associated with survival (P = .76). In nonsurvivors, GLFD was not associated with PLOS (P = .19) or MVD (P = .31).
Conclusion
When controlling for disease severity, hyperglycemia within 24 hours of PICU admission was not independently associated with increased mechanical ventilation time, length of stay, or mortality. Prospective evaluation of glycemic control in critically ill children is needed to elucidate its effects on outcome.
Reprint requests: Robert Rapaport, Mount Sinai School of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Box 1616, One Gustave L. Levy Place, New York, NY 10029
No conflicts of interest or sources of financial assistance to disclose.
ABSTRACT